{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:23:58Z","timestamp":1790029438107,"version":"4.0.1"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Lymphoproliferative disorders (LPDs) are relatively rare but serious complications in patients with rheumatoid arthritis undergoing immunosuppressive therapy. Here, we report a case of methotrexate-associated LPD (MTX-LPD) in a 74-year-old patient with rheumatoid arthritis who presented with multiple pulmonary nodules. Lung biopsy confirmed Epstein\u2013Barr virus-positive diffuse large B-cell lymphoma. The patient had been on low-dose MTX for over 17\u00a0years. Notably, lymphocyte counts were persistently low before LPD onset and gradually improved following MTX discontinuation. Despite the spontaneous regression of LPD following MTX withdrawal and steroid therapy, a second exacerbation occurred, necessitating additional treatment. Fluctuations in lymphocyte count and C-reactive protein levels demonstrated an inverse correlation throughout the disease course. This suggests a strong association between immune reconstitution and LPD remission. We hypothesised that immunosenescence, including age-related changes in T and B-cells, may contribute to impaired immune surveillance and delayed disease resolution. Monitoring lymphocyte counts may be a useful marker for early detection and prognosis of MTX-LPD.<\/jats:p>","DOI":"10.1093\/mrcr\/rxag036","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T12:18:36Z","timestamp":1778674716000},"source":"Crossref","is-referenced-by-count":2,"title":["Rapid progression of methotrexate-associated lymphoproliferative disorder presenting with multiple pulmonary masses in rheumatoid arthritis patient: A case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5835-1482","authenticated-orcid":false,"given":"Mutsuko","family":"Minata","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Kobe Century Memorial Hospital , Kobe, Hyogo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"Department of Hematology, Kobe University , Kobe, Hyogo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Kuroki","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Kobe Century Memorial Hospital , Kobe, Hyogo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026060213212560400_ref1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/ejh.12116","article-title":"Methotrexate\/iatrogenic lymphoproliferative disorders in rheumatoid arthritis: histology, Epstein-Barr virus, and clonality are important predictors of disease progression and regression","volume":"91","author":"Ichikawa","year":"2013","journal-title":"Eur J Haematol"},{"key":"2026060213212560400_ref2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/14397595.2020.1869370","article-title":"Association of methotrexate use and lymphoproliferative disorder in patients with rheumatoid arthritis: results from a Japanese multi-institutional retrospective study","volume":"32","author":"Honda","year":"2022","journal-title":"Mod Rheumatol"},{"key":"2026060213212560400_ref3","doi-asserted-by":"crossref","first-page":"3719","DOI":"10.1111\/cas.15894","article-title":"Lymphoproliferative disorder risk after methotrexate treatment for rheumatoid arthritis","volume":"114","author":"Tanaka","year":"2023","journal-title":"Cancer Sci"},{"key":"2026060213212560400_ref4","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1080\/14397595.2021.1879362","article-title":"Characteristics of rheumatoid arthritis with immunodeficiency-associated lymphoproliferative disorders to regress spontaneously by the withdrawal of methotrexate and their clinical course: a retrospective, multicenter, case-control study","volume":"32","author":"Kuramoto","year":"2022","journal-title":"Mod Rheumatol"},{"key":"2026060213212560400_ref5","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3960\/jslrt.19039","article-title":"The clinical impact of absolute lymphocyte count in peripheral blood among patients with methotrexate - associated lymphoproliferative disorders","volume":"60","author":"Tokuhira","year":"2020","journal-title":"J Clin Exp Hematop"},{"key":"2026060213212560400_ref6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1080\/14397595.2021.1899570","article-title":"Clinicopathological characteristics of lymphoproliferative disorders in 232 patients with rheumatoid arthritis in Japan: a retrospective, multicenter, descriptive study","volume":"32","author":"Takada","year":"2022","journal-title":"Mod Rheumatol"},{"key":"2026060213212560400_ref7","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1038\/s41577-019-0180-1","article-title":"Mechanisms underlying T cell ageing","volume":"19","author":"Goronzy","year":"2019","journal-title":"Nat Rev Immunol"},{"key":"2026060213212560400_ref8","first-page":"389","article-title":"Primary pulmonary diffuse large B-cell lymphoma mimics advanced lung cancer:report of a case","volume":"77","author":"Ito","year":"2024","journal-title":"Kyobu Geka"},{"key":"2026060213212560400_ref9","doi-asserted-by":"crossref","first-page":"441","DOI":"10.3109\/14397595.2014.898559","article-title":"Pulmonary and retroperitoneal lesions induced by methotrexate-associated lymphoproliferative disorder in a patient with rheumatoid arthritis","volume":"26","author":"Yamakawa","year":"2016","journal-title":"Mod Rheumatol"},{"key":"2026060213212560400_ref10","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2017-221778","article-title":"Methotrexate-associated lymphoproliferative disease with multiple pulmonary nodules in a patient with rheumatoid arthritis","volume":"2017","author":"Lai","year":"2017","journal-title":"BMJ Case Rep"},{"key":"2026060213212560400_ref11","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/pin.12346","article-title":"Methotrexate-associated lymphoproliferative disorder presenting as extranodal NK\/T-cell lymphoma arising in the lungs","volume":"65","author":"Tajima","year":"2015","journal-title":"Pathol Int"},{"key":"2026060213212560400_ref12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1080\/14397595.2020.1866837","article-title":"Overall survival and post-spontaneous regression relapse-free survival of patients with lymphoproliferative disorders associated with rheumatoid arthritis: a multi-center retrospective cohort study","volume":"32","author":"Saito","year":"2022","journal-title":"Mod Rheumatol"},{"key":"2026060213212560400_ref13","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s00281-020-00806-z","article-title":"The interplay between immunosenescence and age-related diseases","volume":"42","author":"Barbe-Tuana","year":"2020","journal-title":"Semin Immunopathol"}],"container-title":["Modern Rheumatology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mrcr\/advance-article-pdf\/doi\/10.1093\/mrcr\/rxag036\/68293433\/rxag036.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/10\/1\/rxag036\/68293433\/rxag036.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/10\/1\/rxag036\/68293433\/rxag036.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T17:21:34Z","timestamp":1780420894000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mrcr\/article\/doi\/10.1093\/mrcr\/rxag036\/8678962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,6]]}},"URL":"https:\/\/doi.org\/10.1093\/mrcr\/rxag036","relation":{},"ISSN":["2472-5625"],"issn-type":[{"value":"2472-5625","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026]]},"published":{"date-parts":[[2026]]},"article-number":"rxag036"}}